Aims. Pneumatic tourniquets are often used during the surgical treatment of unstable traumatic ankle fractures. The aim of this study was to assess the risk of reoperation after open reduction and internal fixation of ankle fractures with and without the use of pneumatic tourniquets. Methods. This was a population-based cohort study using data from the Danish Fracture Database with a follow-up period of 24 months. Data were linked to the Danish National Patient Registry to ensure complete information regarding reoperations due to complications, which were divided into major and minor. The relative risk of reoperations for the tourniquet group compared with the non-tourniquet group was estimated using Cox proportional hazards modelling. Results. A total of 4,050 ankle fractures treated with open reduction and internal fixation between 15 March 2012 and 31 December 2016 were included, with 669 (16.5%) undergoing surgery with a tourniquet and 3,381 (83.5%) without a tourniquet. The overall reoperation risk was 28.2% with an adjusted relative risk of 1.46 (95% CI 0.91 to 2.32) for group comparison. The reoperation risk due to major complications was 3.1% with a tourniquet and 4.4% without a tourniquet, resulting in an adjusted relative risk of 1.45 (95% CI 0.91 to 2.32). For minor complications, there were 24.7% and 23.9% reoperations, resulting in an adjusted relative risk of 0.99 (95% CI 0.84 to 1.17). Conclusion. We found no significant difference in the reoperation rate when comparing ankle fractures treated surgically with and without the use of pneumatic tourniquets. Cite this article: Bone Joint J 2024;106-B(9):994–999

The effect of the pneumatic tourniquet on the incidence of postoperative deep venous thrombosis is uncertain. We carried out a controlled study comparing the incidence of deep venous thrombosis when a tourniquet was used with the incidence when a tourniquet was not used. Thrombosis was detected by radioisotope venography. The results of the study showed no difference in incidence and we concluded that the pneumatic tourniquet has no influence on the formation of a thrombus in a deep vein

Experiments have been carried out on rhesus monkeys to determine the effect of the application of a pneumatic tourniquet on the ultrastructure of the muscles of the lower limb. Tourniquets were applied for periods lasting between one and five hours. The changes in the muscle lying immediately under the cuff of the tourniquet were more marked than those observed in muscle distal to the cuff. Three hours appears to be close to the limit of the time that a muscle can resist the sustained compression of a tourniquet

We describe a 31-year-old man in whom a paresis and sensory defect of the left arm developed after amputation of the index finger. The operation was performed in a bloodless field, using a pneumatic tourniquet. The sensory defect resolved in two months and the paresis in five and a half months. We consider that direct pressure produced by the tourniquet caused the nerve lesion. It is probable that the tourniquet was inflated to a pressure of 500 millimetres of mercury instead of the intended 250 millimetres of mercury because of a faulty gauge. In order to avoid this rare complication, it is advisable to check the tourniquet gauge each time before use

The protective effect of local hypothermia was studied in pig's limbs made ischaemic by long, repeated application of a pneumatic tourniquet. Twenty-one Landrace pigs were anaesthetised on two separate occasions six days apart and a pneumatic tourniquet at 500 mmHg pressure was applied to the same forelimb for three and two hours respectively. Ten of the pigs had local hypothermia from cold gel packs placed around the limb during the first tourniquet application; the other 11 had the ischaemic limb exposed to room temperature. In comparison with the normothermic limbs, the hypothermic ischaemic limbs had significant slowing of metabolism. The hypothermic limbs also showed less inflammatory response and a faster rate of recovery, both immediately after removal of the tourniquet, and by the end of the experiment, 10 days after the first tourniquet. Local hypothermia produced by this technique was shown to be safe and effective, while appearing to protect muscles exposed to prolonged tourniquet-induced ischaemia

We report the effect of padding on the efficiency of the pneumatic tourniquet for the upper limb. Varying thicknesses of two commercially-available types of orthopaedic padding (Cellona and Velband) were applied to the arms of 20 volunteers, with three pressure transducers placed directly beneath the padding. A tourniquet was positioned over the padding and inflated to 220 mmHg. Significant reductions in the transmitted pressure were recorded from the transducers with both padding materials. With eight layers of padding, reductions in pressure of 13% (1% to 26%) and 18% (7% to 35%) were seen with Cellona and Velband, respectively. The reduction in pressure with Velband padding correlated with increasing arm circumference (Pearson’s correlation coefficient 0.711, p < 0.001). Studies to date have examined how arm circumference affects the required tourniquet inflation pressure. Our study is the first to investigate the effect of the padding and the findings suggest that using more than two layers results in a significant reduction in the transmitted pressure

The history of surgery is to a large extent written around the record of its technical advances. A pneumatic tourniquet is a humble instrument, when compared with many of the more complicated mechanical devices in the modern operation theatre. Nevertheless, it has played a significant role in making possible the precise operations of present-day orthopaedics. Simple tool though the tourniquet may be, its application carries many potential dangers, and it should only he entrusted to skilled hands

An unusually wide pneumatic tourniquet has recently become available; we provide a simple formula for its use with a low but effective inflation pressure. A prospective, randomised and controlled trial in 600 lower limb and 150 upper limb operations is reported. The wide tourniquet (12.5 cm) was as effective at low pressure as was a conventional tourniquet (9 cm) inflated to significantly higher pressures. Fewer patients suffered from painful paraesthesiae after operation using the broad, low-pressure tourniquet

The effect of the application of a tourniquet to a limb and the release of the accumulated metabolites have been investigated with reference to the acid-base level in the blood from the limb and in the right atrium. Investigations have been carried out experimentally in rhesus monkeys and observations have been made on patients undergoing reconstructive operations on the knee. The acidotic blood from the ischaemic limb produces little systemic effect. The limb recovers in approximately 40 minutes after a tourniquet has been in place for four hours. Three hours is recommended as a reasonable upper limit for the safe application of a pneumatic tourniquet

We studied perioperative pain and postoperative neurological changes after surgery for hallux valgus in 50 patients operated on under local ankle block. Patients were randomised to have the pneumatic tourniquet either at calf level or just above the ankle. The cuffs were inflated to 100 mmHg above systolic blood pressure. One patient was withdrawn from the study after randomisation. Areas of pain, paraesthesia and numbness were marked by patients on a diagram of the foot before operation and at six and ten weeks after operation. Both positions of the tourniquet gave an excellent bloodless field. The proximal tourniquet gave significantly greater discomfort (p < 0.01) during the operation, after 10, 20 and 30 minutes. Application of the cuff at the ankle gave no relative increase in areas of numbness and paraesthesia at six and ten weeks. An ankle tourniquet gives less discomfort with no increase in the incidence of nerve injury

Aims

The ulna is an extremely rare location for primary bone tumours of the elbow in paediatrics. Although several reconstruction options are available, the optimal reconstruction method is still unknown due to the rarity of proximal ulna tumours. In this study, we report the outcomes of osteoarticular ulna allograft for the reconstruction of proximal ulna tumours.

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The mean age of patients undergoing total knee arthroplasty (TKA) has reduced with time. Younger patients have increased expectations following TKA. Aseptic loosening of the tibial component is the most common cause of failure of TKA in the UK. Interest in cementless TKA has re-emerged due to its encouraging results in the younger patient population. We review a large series of tantalum trabecular metal cementless implants in patients who are at the highest risk of revision surgery.

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This study aims to report the outcomes in the treatment of unstable proximal third scaphoid nonunions with arthroscopic curettage, non-vascularized bone grafting, and percutaneous fixation.

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Although absorbable sutures for the repair of acute Achilles tendon rupture (ATR) have been attracting attention, the rationale for their use remains insufficient. This study prospectively compared the outcomes of absorbable and nonabsorbable sutures for the repair of acute ATR.

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In the UK, the NHS generates an estimated 25 megatonnes of carbon dioxide equivalents (4% to 5% of the nation’s total carbon emissions) and produces over 500,000 tonnes of waste annually. There is limited evidence demonstrating the principles of sustainability and its benefits within orthopaedic surgery. The primary aim of this study was to analyze the environmental impact of orthopaedic surgery and the environmentally sustainable initiatives undertaken to address this. The secondary aim of this study was to describe the barriers to making sustainable changes within orthopaedic surgery.

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The aim of this study was to determine the prevalence and impact of tourniquet use in patients undergoing limb salvage surgery with endoprosthetic reconstruction for a tumour around the knee.

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Recent improvements in surgical technique and perioperative blood management after total joint replacement (TJR) have decreased rates of transfusion. However, as many surgeons transition to outpatient TJR, obtaining routine postoperative blood tests becomes more challenging. Therefore, we sought to determine if a preoperative outpatient assessment tool that stratifies patients based on numerous medical comorbidities could predict who required postoperative haemoglobin (Hb) measurement.

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The objective of this study was to compare early postoperative functional outcomes and time to hospital discharge between conventional jig-based total knee arthroplasty (TKA) and robotic-arm assisted TKA.

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We hypothesized that there is no difference in the clinical and radiological outcomes using local bone graft versus iliac graft for subtalar distraction arthrodesis in patients with calcaneal malunion. In addition, using local bone graft negates the donor site morbidity.